This study investigated facial profile changes in hard and soft tissues after orthognathic surgery in Japanese skeletal Class III patients. The subjects were Japanese skeletal Class III patients (surgical group) treated by orthognathic surgery (SSRO)(20 females), and Japanese skeletal Class I, II and III patients with malocclusions (non-surgical group) treated by only orthodontic treatment (30 females), The lateral cephalograms of the initial and posttreatment period were used. The SNA, SNB and ANB angles and HP-Symphysis of the hard tissue, the Profile angle (G-Sn-Pgs), the Naso-labial angle and the E-line to the Upper and Lower lip of the soft tissue were measured on the cephalograms. The changes from the initial state to the posttreatment condition in the 20 skeletal Class III patients were statistically evaluated by Mann-Whitney u-test analysis, and the posttreatment results were compared with those of the 30 patients group by Mann-Whitney u-test analysis. The results were as follows: 1. The SNB angle decreased significantly (from initial to posttreatment)(P<0.01) 2. The Profile angle also decreased significantly in the 20 skeletal Class III patients (P<0.01), 3. There were significant differences between the surgical group and nonsurgical group in ANB (P<0.01), HP-Symphysis (P<0.05), Profile angle (P<0.01), Naso-labial Angle (P<0.05) and E-line to Upper lip (P<0.01) parameters in the posttreatment period, and the surgical group showed a skeletal Class III tendency. Large profile changes were obtained in the results of the surgery patients, but the profile in the posttreatment period had only a slight skeletal Class III tendency.

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Soft tissue changes in the chin were compared between patients undergoing sagittal split ramus osteotomy (SSRO) for mandibular setback with and without reduction genioplasty. Twenty patients with symmetrical skeletal Class III malocclusion were examined. Twelve underwent SSRO alone (group I), and 8 underwent SSRO combined with reduction genioplasty (group II). Reduction genioplasty was performed by two horizontal osteotomies, removing the bony wedge, and posterosuperior movement of the inferior segment of the chin. Lateral cephalograms were obtained preoperatively and 6 months postoperatively. Pre- to postoperative changes in the positions of hard-tissue points (B-point [B], pogonion [Ng], and menton [Me]) and soft-tissue B-point [sB], soft-tissue pogonion [sPog], and menton [sMe] were measured on the cephalograms. The ratio of the soft tis-sue movement to the hard tissue movement was also calculated. Though superior movement of Me was significantly larger in group II than in group I, there were no significant differences in the superior movement ratios of sMe to Me between the two groups. However, the posterior movement ratio of sPog to Pog was significantly larger in group I than in group H. These results suggest that the reduction genioplasty performed by two horizontal osteotomies, removing the bony wedge, and posterosuperior movement of the inferior segment of the chin had little effect on the posterior movement of the chin. Therefore, in patients with skeletal class III malocclusion, reduction genioplasty should be applied mainly to vertical shortening of the chin.

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Purpose: To clarify the clinical significance of sonography for evaluating the location of the maxillary artery in the preoperative assessment of patients with jaw deformities.
Materials and methods: From April through May 2005, 12 patients with carcinoma of the maxillofacial region were enrolled in this study. Every patient was evaluated with sonography and contrast-enhanced CT. The maxillary artery was visualized through the acoustic window composed of the zygomatic arch and mandibular notch using power-Doppler sonography. The patterns of blood flow were divided into two categorie saccording to the interpretation of sonographic findings as follows: clear: continuous cord- or string-like structure, unclear: discontinuous dot-like structure or no apparent blood flow. We compared sonographic findings with the location of the maxillary artery demonstrated on contrast-enhanced CT.
Results: The sonographic interpretation of the maxillary artery was clear in 14 sides and unclear in 10 sides. Of 20 sides in which the maxillary artery was located laterally to the lateral pterygoid muscle on contrast-enhanced CT, the sonographic interpretation of the artery was clear in 14 sides and unclear in 6 sides. Of 4 sides in which the maxillary artery was located medially to the lateral pterygoid muscle, the artery was unclear in all of the 4 sides on sonography.
Conclusions: Although the whole course of the maxillary artery was difficult to visualize, it was suggested that sonography played a complementary role to non-enhanced CT in delineation of the maxillary artery for preoperative evaluation of patients with jaw deformities.

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Surgical orthodontic treatment of jaw deformity with marked maxillo-mandibular dental arch disharmony sometimes requires surgical expansion or reduction of the dentition, and various types of surgical methods have been reported. In this study, surgical lateral expansion was performed in two cases of jaw deformity with a constricted maxillary dental arch, using the Le Fort I osteotomy with a parasagittal split of the palatine bone reported by Obwegeser.
In case 1, since relapse after postoperative orthodontic treatment was not taken into account, the dental arch widthdecreased. In case 2, although surgical expansion was insufficient due to marked constriction of the maxillary dentition, lateral expansion by postoperative orthodontic treatment was performed, and expansion of the maxillary dental arch was possible.
This method was considered useful, since greater palatine arteriovenous and tooth root injury can be avoided. Furthermore, although control of postoperative relapse is important, our results suggested that the maxillary dental arch can be further expanded bypostoperative orthodontic treatment.

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In orthognathic surgery cases, where patients have facial deformities and temporomandibular diseases, like osteoarthritis, exacerbation of the disease after surgery may occur. Therefore, the timing and procedures of the surgery need to be well managed, as well as the control of the occlusion after the operation. We report two cases with maxillary protrusion and mandibular retrognathism combined with severe osteoarthrosis of the temporomandibular joint (TMJ). The patients underwent surgical orthodontic treatment, where the maxilla was impacted and the mandible replaced forwardly. After the surgery, we placed a bone screw at the alveolar bone for the longterm use of intraoral elastics as a fixing to prevent skeletal relapse, and achieved a good functional occlusion and good esthetic results. We consider that the result of these treatments shows the effectiveness of the bone screw for preventing skeletal relapse after operation. Our first case was afemale patient of 18 years old, who reported that at the age of 9, she had received orthodontic treatment due to crowding of theteeth and ended the active treatment when she was 12 years old. She came to our office with an open bite and a posterior mandible placement, which became evident to her a year earlier. In the second case, a 20-year-old female patient reported that at the age of 10 she had clicking at both TMJs, frequently could not open her mouth and often had pain at the TMJ, but she had not sought treatment at that time. The patient came to us citing posterior mandibular placement as her chief complaint. The first case showed clicking at the maximum mouth opening and the second case showed clicking during both the opening and closing of the mouth, without finding the opening difficulties of the mouth that she had had before. Although X-ray and CT images revealed for both cases a severe condylar resorption, the cortical bone was present, with no evidence found by Tc scintigraphy of the TMJ. Both patients received orthodontic treatment prior to surgery, with impaction of the maxilla and forward replacement of the mandible. The bone screw remained for 12 months for the first case and for 7 months for the second case. Although both the facial appearance and the occlusion achieved are good and both have asymptomatic TMJs, the second case showed slight worsening of the condylar deformation after removal of the bone screw.

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